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a Department of
Neurology, Correspondence to: Dr E F M Wijdicks, Department of Neurology, Mayo Clinic W8A,
200 First Street SW, Rochester, MN 55905, USA. Telephone 001 507 284 2511; fax 001 507 284 4795; email wijde{at}mayo.edu
Received 21 July 1998 and in revised form 13 November 1998;
Accepted 24 November
1998
OBJECTIVE
To study the
clinical course and determine predictors of deterioration in patients
with lobar haemorrhages).
METHODSA
comprehensive review of 61 consecutive patients with lobar haemorrhages
was performed. Neurological deterioration was defined as (1) decrease
in Glasgow coma sum score by 2 points, (2) new neurological deficit, or
(3) clinical signs of brain herniation. A univariate logistic
regression was performed and expressed in odds ratios.
RESULTSSixteen
of 61 (26%) patients with lobar haemorrhages deteriorated after
admission. In a univariate analysis, only a Glasgow coma score <14
predicted deterioration (75% of deteriorators
v 24% who did not deteriorate; p<0.0001).
Initial CT characteristics predictive of deterioration included
haemorrhage volume >60 ml (63% v 16%, p<
0.0001), shift of the septum pellucidum (75%
v 36%, p<0.01), effacement of the
contralateral ambient cistern (33% v 0%,
p<0.0001), and widening of the contralateral temporal horn (50%
v 0%, p<0.0001). Patients presenting and
deteriorating within 12 hours of ictus declined due to enlargement of
the haemorrhage. Those who deteriorated more than 12 hours after
initial neurological symptoms, showed increased mass effect secondary
to oedema.
ConclusionPatients
with lobar haemorrhages presenting immediately after ictus are at risk
for deterioration from enlargement of the haemorrhage and predictors of
deterioration may be absent. Patients with large volume lobar
haemorrhages presenting to the emergency department with decreased
level of consciousness and shift on CT are at risk for further
deterioration from worsening oedema. These patients require close
observation and early aggressive management may be warranted.
Keywords:
coma;
intracerebral haemorrhage;
CT;
outcome;
emergency room
© 1999 by Journal of Neurology, Neurosurgery, and Psychiatry
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